Interview With Yale Forensic Psychiatrist Bandy Lee

Introduction: Bandy Lee, M.D., M.Div is an international leader in global violence prevention, through the World Health Organization’s Violence Prevention Alliance and her textbook Violence. She is editor of The Dangerous Case of Donald Trump and president of the World Mental Health Coalition, which issued "recommendations" as well as a “Prescription for Survival.” [Editors' note: Dr. Lee has contributed to Psychology Today in the past.]

DAH: How well can a person with extreme narcissistic traits function toward achieving a distant goal while satisfying the need to be praised and recognized in the short term?

BL: Think of a drowning man gasping for air. He will not be thinking about the distant future, no matter how dire. And when he has a drowning compulsion to create a self-image where he is not so incapable—then all investment goes into that and not what needs to be done in reality.

Pathological narcissism by definition defeats the distant goal because the person is urgently gasping for immediate praise and recognition—reaching for quick coverups if not jealous retaliation against a predecessor who had put a lot of solutions in place.

DAH: Can such a person delay the quick "reward" associated with the need for constant praise and shows of respect to realize an even greater goal that would provide a significant reward at a later time? Real-life example: Could a severely narcissistic executive adjust his need for praise now in favor of retaining his job later and thus getting a greater ego boost later?

BL: That would be healthy and not pathological narcissism. Healthy personality styles, even if narcissistic, are life-affirming in the end. This is why it is critical to consult specialists who can distinguish between the healthy and the abnormal based on a lifetime of studying the characteristics of disease and honing the relevant clinical skills. To a layperson, they may look alike, since the difference is a matter of degree, and pathological degrees are usually unimaginable—it is not what we ordinarily see.

One of the reasons why the public has been so slow to recognize and protect itself from Donald Trump’s pathologies is because of a culture that equates educated, expert opinion with just any random or partisan opinion. This is harmful narcissism, too, since it causes underestimation and normalization of the dangers. It may feel good to think that your opinion is as valid as any expert’s, without needing to put in the effort and the time, but it is wishful thinking and not reality. Our nation is a portrait of suffering for having ignored the experts: mental health experts on the president’s mental condition, and infectious disease experts on the pandemic.

DAH: Some experts argue that Donald Trump's narcissism is undeniable but other people believe he shows a type of resilience. For example, he has repeatedly declared and promoted his failures as victories. There seems to be some sort of controlled and predictable pattern of behavior which may suggest that his need to survive to satisfy his narcissistic needs is so great that he can adjust his decisions to satisfy his narcissistic needs over the long run.

BL: This is not resilience but a pattern of rigidity that is characteristic of pathology. Far from correcting his errors, he doubles down on them, blaming and bullying others to create a façade of success, when he has been failing all along. That the culture is unhealthy enough to buttress someone like him, willing to cover up for him and even admire him, does not make these healthy traits.

Eventually, his maladaptive coping skills will bring on disappointment and downfall, for others but eventually also for himself. Since the pandemic, he has tried to improve the numbers by threatening the Feds, but since that did not work, he is now muzzling science and prematurely “reopening the economy.” He will succeed neither with the economy nor with controlling the pandemic since he is addressing none of the core problems. It may appear effective since the emotional drive to make it so is powerful, but leads ultimately to the damage and destruction that are typical of pathology.

DAH: Is it possible that some individuals with these traits have narcissistic needs so great they will do anything to survive while others will decompensate under stress when their needs are not met?

BL: You are pointing to the greatest danger we are facing right now: the willingness to do anything for psychic survival. Because of his fragile self-image, he will always be in a crisis mode, thinking not, “What do I need to do?” but, “How can I avoid being exposed?” Most of us have a healthy dose of self-esteem so that a fall in approval ratings or challenges to our ways do not lead to catastrophic destructiveness.

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In Trump’s case, he has shown repeatedly that he has very little reserve in himself, which is why we saw a vengeful spree of firings after the impeachment inquiry, and even during the pandemic, the slightest criticism caused him to withdraw funding from or to remove key persons in fighting the pandemic. The reason the United States has now become a pariah state and a threat to the globe causing the pandemic to spiral out of control? The president does not wish to face the fact that he made a mistake.

This is already decompensation, but if you are asking if he will simply collapse, that is unlikely unless some physical ailment strikes him. He more likely will create domestic or international crises so that he can postpone elections, impose martial law, or whatever it takes to stay in power—not that he enjoys the presidency, but because of a pathological drive to “win.” In the most extreme situation, he may readily cross over to annihilating the world and himself, which is why urgent safeguards are needed in the coming months.